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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247202427
Report Date: 12/23/2021
Date Signed: 01/03/2022 08:41:03 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:TERRIE'S TLC SENIOR HOME IIFACILITY NUMBER:
247202427
ADMINISTRATOR:RHODES, THERESE ANNEFACILITY TYPE:
740
ADDRESS:1317 E BROOKDALE DR.TELEPHONE:
(209) 726-0548
CITY:MERCEDSTATE: CAZIP CODE:
95340
CAPACITY:6CENSUS: 0DATE:
12/23/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:39 AM
MET WITH:Albina FloresTIME COMPLETED:
12:55 PM
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On 12/23/2021 Licensing Program Analyst M. Garza arrived at facility unannounced to complete a Case Management visit. LPA was informed by Licensee that facility did not have any residents. No new residents were being accepted so that the facility may remodel. LPA contacted Licensee Therese Rhodes who stated they were unavailable and that Albina Flores will be arriving to complete visit. Ms. Flores arrived a sometime later.

LPA completed a walk through of the facility to verify no residents present during remodel. LPA observed a set of couches in the driveway, along with a walker. Inside of facility was various furniture but no residents or belongings of any residents observed.

Due to COVID precautionary measures a copy of this report will be emailed to Rhodesbuds@yahoo.com. A delivered and read receipt serves as confirmation.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: (559) 365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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